产科急性DIC的诊断与处理体会(附30例临床分析)

目的 :探讨产科急性DIC的临床特点及诊断治疗方法。方法 :对 30例产科急性DIC的临床资料 ,进行回顾性分析。结果 :熟知产科急性DIC的早期临床表现作到早期诊断 ,积极治疗诱发产科急性DIC原发疾病 ,及时去除病因是抢救产科急性DIC的关键。根据诱发疾病及DIC病情选择性使用肝素。结论 :产科急性DIC发病急骤 ,病势凶险 ,死亡率高 ,只要做到早期诊断 ,正确治疗 ,可显著降低死亡率     

抢救产科急性弥漫性血管内凝血3例体会

目的探讨产科DIC早期诊断及把握时机、正确治疗、抢救DIC的方法.方法回顾性分析在本院发生的3例产科DIC,根据诱发DIC的病因、临床症状及实验室检查,尽早作出诊断,积极治疗原发病,去除病因,抗休克,补充血容量,纠正酸中毒,适当使用肝素等抗凝治疗.在此基础上输入新鲜血,补充凝血因子及抗纤溶药物.对无法控制的阴道出血,以手术切除子宫.结果3例产科DIC均治愈.结论早期正确诊断,尽早去除病因,阻断促凝物质继续进入母血循环,在产科方面尽快结束分娩.阴道分娩条件不成熟者,可行剖宫产.产后出血不止,应果断做子宫切除术.同时产科DIC临床以大量出血为特点,在治疗原则上则以输入大量新鲜血及纤维蛋白原为主,抢救患者的失血性休克,此时肝素应用要慎重.     

产科DIG 12例诊治体会

目的:探讨产科DIC的临床特点及诊治策略.方法:对我院收治的12例产科DIC患者临床资料进行回顾性分析.结果:①产科DIC的发生与严重.产科并发症,如重度子痫前期、前置胎盘、胎盘早剥、宫内死胎、产后出血、羊水栓塞、重症肝炎等相关.②12例病例中,抢救成功9例,死亡3例;剖宫产8例,子宫切除4例;围生儿11例,死亡3例.结论:早预防.早诊断,早治疗,积极防治多器官功能衰竭(MODs),是抢救产科DIC的有效方法.     

产科弥散性血管内凝血16例临床分析

目的探讨产科弥散性血管内凝血(disseminated intravascular coagulation,DIC)的早期诊断及有效治疗方法。方法对16例产科DIC患者的临床资料进行回顾性分析。结果 16例中胎盘因素9例;瘢痕子宫3例;双胎妊娠、巨大儿各2例;3例重度子痫前期;软产道裂伤2例,先兆子宫破裂1例;6例合并有两种并发症。子宫动脉栓塞治疗6例,均成功;子宫切除术4例;3例行双侧髂内动脉结扎术,2例未成功,改行子宫切除术。5例经输血和凝血因子,止血成功。1例孕产妇死亡。足月活产11例,早产2例,孕中期因胎盘因素终止妊娠1例,围产儿死亡2例。结论重视对DIC主要诱因的防治,及早识别临床表现,纠正休克、补充凝血因子是提高DIC治愈率的重要手段。子宫切除和子宫栓塞术二者均为治疗产后出血的有效手段。     

小剂量肝素在产科DIC救治中的临床应用(附12例临床分析)

产科弥散性血管内凝血（DIC）是多种疾病以凝血障碍为特征的中间病理过程，发病急骤，居母婴死亡率首位。因此，早期诊断DIC，把握正确治疗时机，尤其是肝素的合理应用是抢救成功的关键。我们应用小剂量肝素治疗了12例DIC患者，取得了较好的效果，现报告如下。     

围产期子宫切除32例分析

目的 :分析产科子宫切除的适应症、并发症及母儿预后。方法 :回顾性分析 7年间 32例产科子宫切除病例。结果 :32例产科子宫切除术中 ,2 3例为急症子宫切除 ,9例为选择性子宫切除。围产儿死亡率 14 7‰。结论 :子宫切除是抢救产科大出血 ,挽救孕妇生命的一项重要且有效的措施 ,也是对产前合并有妇科良、恶性肿瘤及异常子宫出血产妇的一项安全有效的处理方法     

产科急性DIC的诊断与处理(附17例临床病例分析)

产科急性DIC并非独立疾病,而是许多疾病在发展中的一个过程,发病急骤,病势凶险,死亡率较高,如能早期诊断正确治疗,可以显著地降低死亡率。现将我院自1978年以来所治疗的17例产科急性DIC总结如下。临床资料一、产科DIC的诊断标准:本组病例根据1982年6月全国血栓与止血学术会议拟定的DIC诊断标准确定诊断:①存在易于引起DIC的基础疾病;②有多发性出血倾向、末稍循环衰竭或微血管栓塞的临床表现;③实验室凝血功能检查有三项以上异常。     

急症子宫切除术在产科大出血中的应用及评价

目的 探讨产科急症子宫切除术在抢救产科大出血中的应用价值。方法 采用回顾性资料分析方法,对我院1990年～2000年间收治的10例因产科急症行子宫切除术患者的临床资料进行分析。结果 10例均为经保守治疗不能控制的产科大出血患者。其中DIC5例,胎盘粘连2例,宫缩乏力、子宫破裂、剖宫产术后晚期子宫切口感染各1例。出血量l500～3870ml,平均2427ml。10例患者均行急症子宫切除术后痊愈出院。相关因素分析显示,孕产次、多胎妊娠、分娩方式等因素与产科急症子宫切除术相关。结论 产科急症子宫切除术是治疗急性产科大出血的有效措施之一。     

产科急性DIC 21例临床分析

产科急性DIC发病急骤，临床治疗困难，病死率极高。现将我院近10余年来收治的21例产科急性DIC作一总结，进一步探讨产科DIC的抢救防治措施。 资料与方法 1．一般资料：我院自1991年1月～2004年12月住院分娩总数26640例，产科急性DIC21例，其中由外院（乡村诊所）转入4例，发生率0．064％（17／26640），年龄20443岁，平均26．5岁，孕周33%^＋4～42^＋1周，平均39^＋1周，初产妇8例，经产妇13例。21例中产前2例，其中1例为中央型前置胎盘，1例为重度子痫前期合并重症胎盘早剥、胎死宫内；     

14例产科弥散性血管内凝血诊治分析及Takao产科DIC评分系统应用探讨

目的:分析产科弥散性血管内凝血(DIC)的病因、诊断、治疗及结局,探讨Takao产科DIC评分系统在诊断产科DIC中的临床价值。方法:回顾分析2015年1月至2017年12月华中科技大学同济医学院附属同济医院产科收治的14例DIC患者的临床资料,并运用评分系统进行动态评分。结果:产科DIC的发病原因包括产后出血6例(6/14),胎盘早剥5例(5/14),羊水栓塞2例(2/14),急性胰腺炎1例(1/14)。运用Takao产科DIC评分系统评分,得分5～22分。达到DIC诊断标准(≥8分)者10例,5例(5/14)在完成第一阶段治疗后DIC得到纠正。运用国际血栓和止血协会(ISTH)评分系统评分,得分3～8分,达到DIC诊断标准(≥5分)者10例,11例(11/14)完成第一阶段治疗后DIC得到纠正。根据两种评分系统,完成第二阶段治疗后,均余1例患者DIC未能纠正。根据Takao产科DIC评分系统疗效评估标准,第一阶段治疗结束时疗效为显效2例,良好5例,一般3例,恶化4例;完成第二阶段治疗时显效6例,良好5例,一般3例。13例患者经积极治疗后纠正DIC,1例因多器官功能衰竭,抢救无效死亡。结论:产科DIC病情凶险,早期明确诊断、积极治疗是挽救孕产妇生命的关键。建立完善的评分体系对于尽早准确诊断病情、指导治疗有重要意义。     

Clinical evaluation of antithrombin III concentrate (BI 6.013) for disseminated intravascular coagulation in obstetrics. Well-controlled multicenter trial

Antithrombin III (AT III) is known to be the most important inhibitor of serine protease in the coagulation system. In the presence of heparin, AT III is converted from its progressive activity state to an immediate activity state. In disseminated intravascular coagulation (DIC) in the field of obstetrics, the treatment has to be initiated very early. Heparin treatment, on the other hand, is critical since frequently postpartal or postoperative wound bleeding is present. We, therefore, established diagnostic criteria for the early diagnosis of DIC and investigated the clinical efficacy of a therapy with AT III in a well-controlled comparative study versus the injectable synthetic protease inhibitor FOY. The results of the trial showed that the AT III group (92%; n = 24) was significantly (p less than 0.001) superior in clinical efficacy to the FOY group (60%; n = 15). No side effects whatsoever were observed after treatment with AT III concentrate (Behring Institute). From these results, it could be concluded that a single therapy with AT III concentrate can sufficiently control the symptoms of DIC in the field of obstetrics without the risk of increased bleeding.     

妊高征并发急性DIC 26例临床分析

探讨妊高征与急性ＤＩＣ的关系。方法对西安市５所医院１９８０至１９９７年１８年间发生的妊娠高征并发急性ＤＩＣ２６例临床资料进行回顾性分析。结果（１）２６例妊高征并发急性ＤＩＣ中,７例孕产妇死亡,死亡率为２６．９２％,围产儿２９例,１７例死亡,死亡率为５８．６２％。     

妊娠合并急性阑尾炎81例临床分析

目的探讨妊娠合并急性阑尾炎临床特征、诊断及治疗。 方法对2008年1月至2015年12月就诊于广州医科大学附属第三医院妇产科的81例妊娠合并急性阑尾炎住院患者的临床资料进行回顾性分析。 结果(1)临床症状和体征：81例妊娠合并急性阑尾炎,93.83%的患者以腹痛来就诊,具有典型的转移性右下腹痛占28.39%;患者入院平均体温为(37.17±0.70)℃。(2)辅助检查：白细胞(13.82±4.84)×10⁹个/L,中性粒细胞数为(11.72±4.88)×10⁹个/L,中性粒细胞百分比为82.89%,C-反应蛋白为(92.49±61.31)mg/L,降钙素原为(0.20±0.28)ng/ml。(3)治疗：手术治疗者35例,使用抗生素非手术治疗者46例。孕中期行腹式阑尾切除术17例,孕晚期行剖宫产加阑尾切除术18例,术后病理报告类型以急性化脓性阑尾炎(15例)为主。 结论掌握妊娠合并急性阑尾炎的临床特点,做到早期诊断和正确处理对妊娠结局有重要影响。     

Acute blood coagulation disorders in pregnancy--changing patterns in the disease picture

The syndrome of coagulation defects in obstetrics was detected as cause for obstetrical hemorrhage during the 50 years. Some of the etiologic factors like the dead fetus syndrome or the salting out syndrome have vanished. Amniotic fluid embolism is the only syndrome which is clearly associated with disseminated intravascular coagulation. This connection between premature separation is less clear. One concept assumes that the plasma fibrinogen concentration is low because it is consumed in the retroplacental hematoma. Heparin treatment can be fatal if DIC is mistaken with a "loss coagulopathy", which is at present mostly responsible for coagulation defects and obstetrical hemorrhage. This indicates a change in pattern of disease which is due to a better pathophysiologic understanding.     

羊水栓塞DIC的处理及肝素使用问题

弥散性血管内凝血（disseminated intravascular coagulation，DIC）是羊水栓塞（amniotic fluid embolism，AFE）病理改变的重要原因之一。DIC造成大量凝血因子消耗和红细胞破坏，并加重肺动脉高压，也是AFE出血的主要原因。早期发现DIC，有助于AFE的诊断。减少促凝物质进入血液循环、抗凝治疗可阻断DIC的进一步发展。肝素应在DIC高凝期或低凝期早期使用，同时需补充凝血因子，监测凝血功能的变化。     

Chronic diffuse intravascular coagulation (DIC) in nonmetastatic ovarian cancer: Report of a case and review of the literature

A patient with a dramatic clinical picture of cerebral artery occlusion, peripheral artery occlusion, and pulmonary embolism was diagnosed as suffering from disseminated intravascular coagulation (DIC) according to the typical laboratory findings of hypofibrinogenemia, hypoprothrombinemia, relative thrombocytopenia, and reduction of other clotting factors. Increased fibrinogen split products (FSP) were found on several occasions later in the disease. Heparin was effective in controlling the syndrome which recurred when treatment was stopped. The cause of the syndrome was an ovarian tumor. The patient died of acute myocardial infarction. The postmortem examination confirmed the diagnosis of DIC, the primary disease being a mucinous cystadenocarcinoma of the right ovary, and revealed that the terminal myocardial infarction was also the result of DIC. The surprise was that the tumor was solitary and without metastases. The literature dealing with chronic DIC in cancer is reviewed, and its diagnosis, frequency, and association with metastases is assessed.     

A typical case of DIC precipitated by cesarean section done for severe toxemia of pregnancy and a follow up laboratory study of the progress of DIC

A typical case of DIC presumably precipitated by cesarean section done for severe toxemia of pregnancy is reported. A laboratory study followed up the progress of DIC, especially of the drop in the consumptive platelet count and fibrinogen level as a result of excessive blood clotting. In this case the patient was a 29-year-old nulliparous gravida 1 who developed severe toxemia at 29 weeks and underwent a cesarean section for fetal distress at 33 weeks, although the baby died immediately after birth. On the following day of operation slight bleeding from the operative wound occurred and she had pertinent laboratory tests, which yielded a platelet count of 81,000/mm3, plasma fibrinogen level of 200mg/dl and FDP of 160 micrograms/ml and led to a diagnosis of DIC. While placing her on replacement and adjunctive therapies the laboratory tests were performed serially, which permitted a close follow-up observation of the subsequent progress of DIC with the detection of lowered platelet counts and fibrinogen levels as administration of Heparin resulted in an increase in the amount of bleeding, FOY, 800mg/day, was instituted and following this treatment the DIC disappeared.     

Choriocarcinoma with diffuse intraabdominal abscess and disseminated intravascular coagulation. A case report

BACKGROUND: Management of choriocarcinoma complicated by diffused intraabdominal abscess is difficult, especially when disseminated intravascular coagulation (DIC) ensues. CASE: A 29-year-old woman presented with massive vaginal bleeding, fever and severe abdominal pain. Choriocarcinoma with pulmonary and vaginal metastases was diagnosed along with diffused intraabdominal abscess. Hysterectomy and hypogastric artery ligation were performed after the fever and abdominal symptoms failed to respond to intravenous antibiotics. Although the patient developed DIC after surgery, transfusion, antibiotics and immediate combination chemotherapy improved her condition and controlled the malignancy. She was free of disease for > 20 months after treatment. CONCLUSION: Timely surgery, aggressive antibiotics and immediate postoperative chemotherapy are recommended for patients with choriocarcinoma complicated by intraabdominal abscess and DIC.     

异位妊娠他科误诊致失血性休克临床分析

目的探讨异位妊娠他科误诊原因，减少误诊率。方法回顾性分析我院2000年1月-2005年6月收治435例异位妊娠中9例因临床表现异常首诊到内外科室就诊，分析异常临床表现及原因。结果2例腹泻伴下腹隐痛于肠道门诊就诊，2例发热、呕吐、下腹痛于内科就诊，3例胃痛伴呕吐及上腹痛伴呕吐于外科就诊，2例晕厥腹痛于急诊科就诊，经对症处理，最短5h、最长72h内出现休克症状而请妇科会诊，后诊断异位妊娠、失血性休克，急诊手术、积极抢救转危为安。结论生育期妇女要考虑妇科疾患，特别是异位妊娠，常规查尿HCG、盆腔B超可得到及时诊断。     

Diagnosis and treatment of high-risk metastatic gestational trophoblastic neoplasia in Hungary

OBJECTIVE: To review results in treatment of high-risk metastatic gestational trophoblastic neoplasia (GTN) in Hungary. STUDY DESIGN: Between January 1, 1977, and December 31, 2006, 142 patients with high-risk metastatic GTN were treated. Patients were 14-51 years of age (average 27.9). We selected primary chemotherapy based on patient GTN stage and prognostic score. RESULTS: Methotrexate, actinomycin-D and cyclophosphamide (MAC) as a primary therapy was used in 100 cases and as second-line chemotherapy in 6 cases. Of the 100 cases, 95 achieved complete remission. Twenty-one high-risk patients were treated with etoposide, high-dose methotrexate with folinic acid rescue, actinomycin-D, cyclophosphamide and vincristine (EMA-CO). Of 17 primary therapies, 13 patients achieved complete remission. Primary cisplatin, etoposide and bleomycin (CEB) was successful in 12 of 14 high-risk cases. Hysterectomy was performed in 42 of 142 high-risk patients; metastases were resected in 26 of 142 of high-risk patients. Comparison of mean prognostic scores resulted in significant differences between CEB and MAC, CEB and EMA-CO and MAC and EMA-CO. CONCLUSION: Results support that patients with high-risk metastatic GTN should primarily be treated with combination chemotherapy. Our data support the effectiveness of MAC, EMA-CO and CEB regimens.